01 ahmed omar leprosy -last edition
TRANSCRIPT
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LeprosyPh. Ahmed Omar
:-صلى هللا عليه وسلم -قال النبي
صحيححديث« فِرَّ من المجذوم فِرارك من األسد »
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Introduction• Leprosy (also known Hansen’s
Disease)is an infectious chronic disease
caused by Mycobacterium leprae which
involves the skin and peripheral nerves.
• At 1873 , Gerhard Hansen was the first
person to identify the bacteria that cause
leprosy under microscope .
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Epidemiology• According to WHO, between 1985 and 2010, the number
of registered cases fell from 5.4 million to 244,796.
• Most cases from India, Brazil, Bangladesh and Nigeria.
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Tranmissition
• Respiratory droplets ( common )
• Skin contact
• Feeding
the person who talking medication over than weak is not
contagious.
about 95% of people have natural immunity against
M.leprea .
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pathogenesis
Respiratory system or skin
Engulfed by macrophage but
Still alive ( replication )
peripheral nerves ( Schwann cell )
Nerves damage
N.B.- replication period is very slow (~ 13 day )
-Incubation period 2 –12 years as an average
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Classification of leprosy • Ridley-Jopling classification:(cutaneous and neurological
disordrs)
o Tuberculoid Leprosy (TT)
• Hypopigmented macule
• High immunity
• No pain at lesions
o Lepromatous Leprosy (LL)
• Papules and nodules
• Pain at nodules and papules
• Low immunity
There also classes between e.g. Borderline
tuberculoid (BT), Borderline Leprosy (BB) and
Borderline lepromatous (BL)
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Classification of leprosycont.
• WHO classification : ( number of lesions )
o Paucibacillary (PB) :
• Five lesions or less
• refers to TT and BT
o Multibacillary (MB) :
• Six lesions or more
• refers to BB, BL and LL
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Symptoms in general
• White patches ( no pain )
• Swollen nerves
• Papule and nodule ( painful )
• Loss of sensation
• Loss of fingers and toes( due to injuries, secondary infections and cartilage destruction)
• Deformity of nose ( cartilage destruction)
• Claw hand ( nerve damage paralysis )
• Eye problems that may lead to blindness
etc…
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Reactions of leprosy
• These are acute episodes that occur during the chronic
course of multibacillary leprosy. They may occur
spontaneously or may be precipitated by :
– treatment, infections, physical stress, injury,
operations, pregnancy, parturition or vaccination.
• Types of Reactions:
– Type I Reaction
– Type II Reaction
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Type I Reaction
• Type of immunity:
– Type IV (cell mediated)
(delayed hypersensitivity reaction)
• Skin:
– Acute inflammation of existing lesions.
• Nerves:
– Swelling with pain & Tenderness →Paralysis.
• Systemic disturbances:
– None.
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Type II Reaction
• Type of immunity:
– Type III (immune complexes).
• Skin:
– Erythema nodosum leprosum (ENL)
• Nerves: – Mild nerve damage.
• Systemic disturbances:
– Fever, malaise, iritis, dactylitis, arthritis, neuritis and
myositis. due to deposition of immune complexes in this
sites
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Diagnosis
1. Clinical Manifestations: ( anesthesia, lesions, nerve
swelling ) .
2. Lepromin test : (immunity test to determine type of
leprosy ) by intradermal injection of heat killed bacteria.
Strongly positive : high immunity ( TT )
Weakly negative : ( BT )
Negative : low immunity ( BB, BL and LL)
If a normal person in an endemic area is lepromin
negative; he is liable to contract leprosy due to
absence of cell-mediated immunity
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Diagnosis cont.
3. Skin Smear : ( Ziehl Neelsen stain ) for acid fast
mycobacteria.
o Absent bacteria : Paucibacillary Leprosy
o Present bacteria: Multibacillary Leprosy
4. Polymerase chain reaction ( PCR )
5. Nerve biopsy
N.B. Culture not applicable , as M.leprea not grow in
vitro
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Treatment
multiple-Drug-Therapy ( MDT ) :
Dapsone ( bacteriostatic ) cheapest and most
important.
Rifampicin ( bactericidal ).
Clofazimine ( bacteriostatic and anti-inflammatory ).
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Treatment cont.
In Paucibacillary Leprosy (PB) :
Day 1 :
Rifampicin ( bactericidal ) 600 mg / once monthly.
Dapsone ( bacteriostatic ) 100 mg.
Day 2 – 28 :
Dapsone ( bacteriostatic ) 100 mg / daily.
This course for 6 months
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Treatment cont.
In Multibacillary Leprosy (MB) :
Day 1 :
Rifampicin 600 mg / once monthly
Dapsone 100 mg
Clofazimine (anti-inflammatory) 300 mg
Day 2 – 28 :
Dapsone 100 gm / daily
Clofazimine 50 mg / daily
This course for 12 months
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Treatment cont.
• These medications are free from WHO
for leprosy patients anywhere on earth.
• Also we use prednisolone and thalidomide as anti-
inflammatory for leprosy reactions.
• Also, reconstructive surgery to repair nerves damage.
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Prevention• Isolation الدقهلية-أبو زعبل -مستعمرة الجذام ) )
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References
• www.uptodate.com
• http://www.who.int/mediacentre/factsheets/fs101/en/
• http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm107296.htm
• https://web.stanford.edu/class/humbio103/ParaSites2005/Leprosy/history.htm
• http://www.leprosy.org/leprosy-faqs/
• http://www.cdc.gov/leprosy/symptoms/index.html
• http://apps.who.int/medicinedocs/en/d/Jh2988e/6.html